Shelly 
Source / Disclosures
Disclosures: Landy does not report any relevant financial disclosure. Please see the study for relevant financial information from all other authors.
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Clinician-free sampling and self-sampling “dramatically increased” the uptake of cervical cancer screening among women aged 50 to 64 who were late for screening, according to the researchers. researchers.
The American Cancer Society has predicted that nearly 15,000 new cases of invasive cervical cancer would be diagnosed in the United States in 2021, and that the average age at diagnosis of the disease is 50 years. CDC researchers have previously reported that the percentages of American women who have never had a Pap test or not in the past 5 years are 11.7% among those aged 46 to 50, 11, 3% among 51 to 55 year olds, 17.1% among 56 to 60 year olds, 18.4% among 61 to 65 year olds and 23.6% among 66 to 70 year olds.
“More than a third of cervical cancer deaths occur at age 65 and over in the United States. ” Rebecca Landy, PhD, a postdoctoral fellow in the division of cancer epidemiology and genetics at the National Cancer Institute, told Healio. “We know that cervical screening is very effective in preventing cervical cancer, but screening rates are lower in old age, in part because current screening methods ( with a speculum) can become particularly uncomfortable for women after menopause. “
One solution to screening is self-sampling, “but a lot of women worry that they haven’t taken the sample correctly,” Landy said.
“Offering a clinician-collected sample without the use of a speculum may appeal to these women; this is the first study to try this, ”Landy said in the interview.
Landy and her colleagues conducted a randomized controlled trial on 784 women who attended one of 10 clinics in the UK. All of the women were between the ages of 50 and 64, and the majority were Caucasian. It had been between 6 and 15 years since the participants were last screened for cervical cancer.
Women were randomly assigned in an approximate 1: 1 ratio to receive the usual procedure or care. The intervention consisted of a letter inviting the women to participate in the study, either by making an appointment at their clinic for a speculum-free screening, or by ordering a kit to collect their own sample. For those who participated in the self-sampling, the women collected the sample using a vaginal swab or brush and used a prepaid envelope to submit the sample, the researchers said.
Women in the usual care cohort were offered cervical screening every 5 years until they reached age 64 and remained eligible for screening between invitations if they were late. Clinics that participated in the study were asked to make it easier for women to make screening appointments, Landy and colleagues wrote in the British Journal of General Practice.
Researchers reported that 4 months after the women were randomized, uptake of cervical cancer screening was significantly higher in the intervention cohort than in the usual care cohort (20.4% vs. 9%; absolute difference = 15.5%, 95% CI, 11-20). The increase between the two cohorts was maintained at 12 months (30.5% vs. 13.6%; absolute difference = 17%, 95% CI, 11.3-22.7).
In addition, the attendance of women for cervical cancer screening via a speculum within 12 months was “very similar” for the two cohorts (12.7% vs. 13.6%). Half of white women chose self-sampling, and most women from Asia (53.3%), black (71.4%), or from other under-represented groups (66.7%) did chose speculum screening.
“Neither autosampling nor speculum-free samples are currently FDA approved, so they cannot yet be offered to women, but this study suggests that alternative collection methods may increase the proportion of unspecified patients. practitioners who are screened, ”Landy said.
The American Cancer Society encourages screening for cervical cancer through only one HPV test every 5 years for every woman with a cervix from the age of 25 to 65. If the HPV test alone is not available, these women should be screened with an HPV / Pap test every 5 years or a Pap test every 3 years. After 65 years of age, and if all previous tests were normal, screening may stop.
the The US Task Force on Preventive Services recommends that women aged 21 to 29 be screened for cervical cancer every 3 years via a Pap test, while women aged 30 to 65 should have either a Pap test every 3 years or the HPV test at high risk every 5 years. The USPSTF says there is insufficient evidence to recommend screening in women aged 65 and older.
The references:
Explanation of updated ACS guidelines for cervical cancer screening. https://www.cancer.gov/news-events/cancer-currents-blog/2020/cervical-cancer-screening-hpv-test-guideline. Accessed January 7, 2022.
Key statistics for cervical cancer. https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html. Accessed January 7, 2022.
Landy R, et al. Fr J Gen Practice. 2021; doi: 10.3399 / BJGP.2021.035.
White MC, et al. Am J Previous With. 2017; doi: 10.1016 / j.amepre.2017.02.024.
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